Tyramine is one of the primary substances that migraine diets attempt to eliminate. Tyramine occurs naturally in many foods and increases in potency when the protein in food ages. It is though to trigger migraine by dilating then constricting blood vessels in the brain, setting off a chain reaction that leads to a migraine episode.
It is important to avoid foods that contain tyramine, but also to eat food that is as fresh as possible to avoid the additional tyramine that develops as food sits. This is the most daunting part of the diet for me. Foods (especially high-protein foods like meat) should be cooked within a couple days of being purchased and leftovers should be frozen within 48 hours. To eliminate as much tyramine as possible, I cook or freeze ingredients within 24 hours of purchasing them and freeze leftovers within 24 hours of preparation. Frozen vegetables are an easy way to do this and they are usually picked and frozen at their nutritional peak.
The American Headache Society supports that Traditional & “Sham” Acupuncture Both Effective for Migraine Relief. In contrast, after reviewing the studies mentioned in the AHS press release, Steven Novella of NeuroLogica Blog claims that the American Headache Society Recommends Placebos for Migraine. He writes,
Studies show that sham acupuncture is as effective as true acupuncture, and Dr. Dodick concludes from this that both work. The proper scientific interpretation of this result is that the treatment (acupuncture) is no different than placebo (sham acupuncture) and therefore has only a placebo effect.
Novella’s argument is sound and I agree with his conclusions. What intrigues me is why the American Headache Society and its president, David Dodick, are touting the benefits for acupuncture when the science is weak. Is it that there are so few effective treatments for migraine that even those without strong evidence are considered worthwhile?
It reminds me of when I was considering Botox injections and was surprised to find that studies only showed minor reductions in headache days of participants. From headlines, you’d think Botox had eradicated migraine, but studies have had only modest results.
The paltry options for treating migraine and the lack of funding for migraine research are disheartening. Urge Congress to take notice by signing the Alliance for Headache Disorders Advocacy’s petition.
Thanks to reader C. Peterson for sharing NeuroLogica Blog’s post.
I don’t normally republish press releases without further investigation, but I’m going to today because 1) It is from the American Headache Society and quotes my headache specialist, whom I trust immensely; 2) It provides a novel, scientific perspective on why acupuncture may help migraine (the focus is on endorphins and the effect they have on inflammation and pain signals, not the usual talk of meridians and energy flow); and 3) I have a killer migraine.
American Headache Society Supports the Use of Acupuncture in Migraine Treatment: Both Traditional Acupuncture and “Sham” Acupuncture Provide Relief
Mt. Royal, NJ (February 1, 2012) – When it comes to treating migraine, so-called “sham” acupuncture (where needles are inserted only to a superficial depth in the skin and not in specific sites) and traditional acupuncture where needles are inserted in specific sites, both are effective, according to the American Headache Society (AHS).
Citing publicity surrounding a recent Canadian study comparing the effectiveness of the two types of acupuncture, David W. Dodick, MD, AHS president, said both types of acupuncture, particularly when electrical stimulation is involved, may work to release endorphins that are important in controlling signals of pain and inflammation.
“How much of a benefit sham acupuncture can have on the release of these chemicals is unclear,” he said. “This suggests the benefits of treatment may not depend on the exact technique of acupuncture and needle positioning.”
There is ample evidence supporting the value of acupuncture in migraine treatment, Dr. Dodick noted, including four studies that compared acupuncture to standard migraine preventive medications. Acupuncture was found to be at least as effective and produced fewer side effects. Further, he noted that a randomized clinical trial study published in November comparing acupuncture to topiramate in chronic migraine prevention showed that acupuncture was more effective than topiramate. Topiramate is an anticonvulsant often used in epilepsy.
Dr. Dodick said that needle positioning may be less relevant than acupuncturists believe, and acupuncture should be offered to patients as part of their options for migraine management. “Further, the long-lasting effects of acupuncture, given that subjects continued to experience a reduction in migraine frequency two months after treatment, is also noteworthy and not a point to be ignored,” he said.
“Along with biofeedback training, cognitive-behavioral therapy, and lifestyle changes, acupuncture provides some migraine sufferers with a safe, non-pharmacologic treatment choice, and one that can also be used during pregnancy,” Dr. Dodick said.
After purposefully not making any resolutions for 2012 (I’ve decided to embrace my flaws instead of constantly trying to fix myself), I find myself on the second day of the new year plotting the most extreme migraine diet I’ve ever done. The diet will be guided, in part, by Heal Your Headache: The 1-2-3 Program for Taking Charge of Your Pain, a book whose author’s attitude I find offensive. I have long thought food triggers for migraine are overrated and I’ve never had relief with long-term migraine diets, yet I’m cross-checking lists of triggers and wondering if bland will be the flavor of the next four months. Desperation is powerful motivation.
I’m using Heal Your Headache as a basic starting point and also avoiding other foods that are high in tyramine (including those that are listed as OK in moderation) or tannins. Science hasn’t found a clear correlation between particular foods (or particular chemicals in foods) and migraine, so I’m relying on anecdotal evidence I’ve heard and read over the years. That’s right, there’s not much logic to my diet plan, just the stories from people who read this blog and the overwhelmingly positive reviews on Amazon. Have I mentioned that I am desperate?
I’ve included some links to previous posts I’ve written about food triggers, but I had to stop looking at them for fear that I would discourage myself from trying again. Instead, I’m telling myself that maybe this time will be different. Maybe I’ll be more disciplined, maybe I’ll get enough cooking help from family that I’ll have adequate nutrition, maybe climate was a factor in previous attempts and I’ll be more successful in the relatively steady barometric pressure of Phoenix. Maybe, maybe, maybe it will be different this time.
Please, migraine gods, let it be different this time.
It was 5:30 Saturday morning and I couldn’t sleep. Knowing I wouldn’t wake up early enough to go to the farmers’ market before yoga, I debated which one to go to. Images of the apple hatch chile cobbler I would make from my market spoils evaporated as I recognized that yoga is not optional. It was an astonishing revelation. The surprise wasn’t in the realization itself, but from the fact that it had never occurred to me before.
I usually feel better after yoga than I do after acupuncture, physical therapy or visits with my doctor, yet yoga doesn’t have the same priority as medical appointments, which are practically sacred. I schedule appointments for the time of day I’ve been feeling best, arrange back-up transportation in case I’m not up for driving, and only cancel if I am absolutely certain I will be miserable if I go. I’d never skip an acupuncture appointment to go to a baseball game, but I have chosen baseball over yoga before. Psychologically, I treated yoga as a fun (and thus optional) activity, not a health necessity.
Getting to class regularly was as simple as shifting yoga into the mental category of mandatory medical activity. I initially worried that medicalizing something I love would hinder my enjoyment of it, then the simple beauty emerged: Migraine allows me to spend 90 minutes a day in one of my favorite activities. If I were healthy, I’d be rushing to maximize 30-minute workouts, thinking that an hour and a half of yoga each day was a wasteful indulgence.